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A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study.

Taylor E, Haven K, Reed P, Bissielo A, Harvey D, McArthur C, Bringans C, Freundlich S, Ingram RJ, Perry D, Wilson F, Milne D, Modahl L, Huang QS, Gross D, Widdowson MA, Grant CC, SHIVERS Investigation Te - BMC Med Imaging (2015)

Bottom Line: Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0).This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity.The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.

View Article: PubMed Central - PubMed

Affiliation: Starship Children's Hospital, Auckland, New Zealand.

ABSTRACT

Background: The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system.

Methods: We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0).

Results: Agreement between the two pediatric radiologists was very good (κ = 0.83, 95% CI 0.65-1.00) and between the two adult radiologists was good (κ = 0.75, 95% CI 0.57-0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good (pediatrician vs. physician:κ = 0.85; vs. pediatric resident:κ = 0.81; vs. medicine resident:κ = 0.76; vs. research nurse:κ = 0.75; vs. medical students:κ = 0.63 and 0.66). Following review of discrepant CXR report scores by clinician pairs, κ values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99.

Conclusions: This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.

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Distribution of radiologist’s chest radiograph scores for children and adults hospitalized with a serious acute respiratory infection
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Fig3: Distribution of radiologist’s chest radiograph scores for children and adults hospitalized with a serious acute respiratory infection

Mentions: The median (interquartile range) age of the children with SARI was 1 (0–3) year of age and of the adults was 60 (42–75) years of age. Sixty-five (50 %) of the adults were smokers, of whom 18 (28 %) were current smokers. The most common presenting syndromes among the children were suspected pneumonia (42 %) and suspected bronchiolitis (36 %), and among the adults were suspected pneumonia (39 %) and febrile illness with respiratory symptoms (25 %). Median length of hospital stay for children and adults was 3 days. Ten percent (children 17 %, adults 3 %) required intensive care. Laboratory testing identified influenza viruses in 23 % of SARI cases and non-influenza respiratory viruses (respiratory syncytial virus, rhinovirus, parainfluenza virus types 1–3, adenovirus, or human metapneumovirus) in 43 %. In 12 (10 %) children and one (1 %) adult co-detection of influenza and a non-influenza virus occurred. The proportion of SARI cases that were influenza positive was similar for children versus adults (21 % vs. 25 %, P = 0.43). A larger proportion of the SARI cases in children, compared to adults, were positive for non-influenza respiratory viruses (81 % vs. 25 %, P < 0.001). A larger proportion of the SARI cases in children, compared to adults were assigned a principal discharge diagnosis code for a respiratory illness (95 % vs. 74 %, P < 0.001). The distribution of CXR scores across the five scoring categories differed between children and adults (P < 0.001; Fig. 3).Fig. 3


A chest radiograph scoring system in patients with severe acute respiratory infection: a validation study.

Taylor E, Haven K, Reed P, Bissielo A, Harvey D, McArthur C, Bringans C, Freundlich S, Ingram RJ, Perry D, Wilson F, Milne D, Modahl L, Huang QS, Gross D, Widdowson MA, Grant CC, SHIVERS Investigation Te - BMC Med Imaging (2015)

Distribution of radiologist’s chest radiograph scores for children and adults hospitalized with a serious acute respiratory infection
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4696329&req=5

Fig3: Distribution of radiologist’s chest radiograph scores for children and adults hospitalized with a serious acute respiratory infection
Mentions: The median (interquartile range) age of the children with SARI was 1 (0–3) year of age and of the adults was 60 (42–75) years of age. Sixty-five (50 %) of the adults were smokers, of whom 18 (28 %) were current smokers. The most common presenting syndromes among the children were suspected pneumonia (42 %) and suspected bronchiolitis (36 %), and among the adults were suspected pneumonia (39 %) and febrile illness with respiratory symptoms (25 %). Median length of hospital stay for children and adults was 3 days. Ten percent (children 17 %, adults 3 %) required intensive care. Laboratory testing identified influenza viruses in 23 % of SARI cases and non-influenza respiratory viruses (respiratory syncytial virus, rhinovirus, parainfluenza virus types 1–3, adenovirus, or human metapneumovirus) in 43 %. In 12 (10 %) children and one (1 %) adult co-detection of influenza and a non-influenza virus occurred. The proportion of SARI cases that were influenza positive was similar for children versus adults (21 % vs. 25 %, P = 0.43). A larger proportion of the SARI cases in children, compared to adults, were positive for non-influenza respiratory viruses (81 % vs. 25 %, P < 0.001). A larger proportion of the SARI cases in children, compared to adults were assigned a principal discharge diagnosis code for a respiratory illness (95 % vs. 74 %, P < 0.001). The distribution of CXR scores across the five scoring categories differed between children and adults (P < 0.001; Fig. 3).Fig. 3

Bottom Line: Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0).This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity.The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.

View Article: PubMed Central - PubMed

Affiliation: Starship Children's Hospital, Auckland, New Zealand.

ABSTRACT

Background: The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system.

Methods: We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4-0.6), good (κ > 0.6-0.8) and very good (κ > 0.8-1.0).

Results: Agreement between the two pediatric radiologists was very good (κ = 0.83, 95% CI 0.65-1.00) and between the two adult radiologists was good (κ = 0.75, 95% CI 0.57-0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good (pediatrician vs. physician:κ = 0.85; vs. pediatric resident:κ = 0.81; vs. medicine resident:κ = 0.76; vs. research nurse:κ = 0.75; vs. medical students:κ = 0.63 and 0.66). Following review of discrepant CXR report scores by clinician pairs, κ values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99.

Conclusions: This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.

Show MeSH
Related in: MedlinePlus